Provider Demographics
NPI:1467676569
Name:BURNETT, MIRIAM JULIETTE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:JULIETTE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:171 GRAVES RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1100
Mailing Address - Country:US
Mailing Address - Phone:770-328-2002
Mailing Address - Fax:877-697-1994
Practice Address - Street 1:560 GREISON TRL
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1874
Practice Address - Country:US
Practice Address - Phone:678-423-6716
Practice Address - Fax:770-253-1519
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA37158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF24977Medicare UPIN